There’s no way to sugarcoat it, a top MUHC official warned staff in an internal letter sent in February: For the McGill University Health Centre to meet its 2015-2016 budget more beds will have to close.

Included among the services that will be cut this summer are the short-stay beds in the MUHC’s emergency department at the Montreal General Hospital and the Glen site in Notre-Dame-de-Grâce.

The letter, sent by Ewa Sidorowicz, MUHC director of professional services, lays the blame for the bed closures on the Quebec Health Department. The latest cuts are retroactive to November. That’s when the province informed the MUHC “in no uncertain terms” that it would fund 85 per cent of the hospital network’s 832 beds, down from what had been budgeted before, 91 per cent of 853 beds, Sidorowicz said.

“That translates into a $13-million compression on the in-patient units,” Sidorowicz said in the letter, a copy of which was obtained by the Montreal Gazette. “The bottom line is that in order to achieve our target we will need to operate at 799 beds” across the network, which includes the Montreal Children’s, the Royal Victoria, the Montreal General and the Montreal Neurological Institute and Hospital. It’s not clear why but the Lachine Hospital with its new dialysis unit, while part of the MUHC, is excluded from cost-cutting closures.

In addition, several hospital in-patient wards, including units in emergency, psychiatry and geriatrics, will shut down during holidays. These “seasonal closures of several weeks” across all sites are to take place during spring break, summer, and Christmas-New Year’s holidays — meaning that for nearly three months of every year several wards will close.

It’s unbelievable, said MUHC family physician Cynthia Stolovitz, that the superhospital (incorporating the Royal Vic, the Children’s and Chest Institute) has been open less than a year and already it’s forced to scale back to avoid running a deficit.

While top MUHC officials have been bracing since November for a cut in beds and services, Sidorowicz’s letter — explaining how closures will play out in individual hospital units — was a surprise to most staff.

“We were shocked. The cuts are so sudden and so drastic,” said Stolovitz, who works part-time in the ER short-stay unit at the Glen. What will happen to patients, she wondered, who are now funnelled through the short-stay unit in the emergency department that’s slated to close throughout the summer?

That unit is a transition ward set up to relieve overcrowding in the emergency room.

It manages patients with complex medical and surgical conditions, including geriatrics and oncology, who need a short admission to the hospital, three to four days, so their conditions can stabilize. For example, cancer patients go to the ER when they have problems with their medications. Patients with an abdominal bleed or a kidney stone who need to be monitored, a senior with pneumonia, or a drop in blood pressure — this is the place where they are followed before being moved to other wards for treatment, surgery or released home.

“This unit is always at 100-per-cent capacity, always turning people over,” Stolovitz said, noting that 40 per cent of patients in the short-stay unit are elderly.

As of June 24, the MUHC will close the emergency department’s 20 short-stay beds, 10 at the Glen and another 10 at the Montreal General. But it’s not clear whether the unit will reopen in the fall, Stolovitz said.

Those who require a short admission will have nowhere to go, she said. “They will be stuck in the ER praying for a bed or they will be sent home prematurely. That’s done all the time because they need the bed. And we will see them bounce back to us (the emergency room) within 48 hours.”

The impact of the closures will be felt throughout the hospital network, Stolovitz warned, because a reduction in beds and services will mean fewer positions for doctors, nurses, among other professionals: “It’s terrible for patients.”

***

Since December, the MUHC accelerated its efforts to “align our clinical plan” with budget compressions, but staff learned of impending cuts through information leaked to the media.

Dr. Gerald Fried, MUHC chief of surgery, warned that up to 1,500 elective operations a year in the hospital network will have to be cancelled because of budget cutbacks. MUHC chief of geriatrics, Dr. José Morais, raised concerns about the possible closing of 15 acute-care beds for the elderly. Dr. Robert Turcotte, MUHC chief of orthopedic surgery, told the Montreal Gazette that delays and the lack of timely access to urgent surgery borders on “mistreatment of patients.”

Sidorowicz’s letter was sent shortly after 30 frustrated physicians signed a letter last month denouncing the hospital’s proposal to dismantle the MUHC’s renowned Women’s Health Mission and folding its research and services into other departments to “implement cost-saving measures.”

In her letter Sidorowicz said she regretted “communication has been slow … It has been a difficult exercise; communicating to all of you in real time such a complex and rapidly evolving conversation, has been daunting and admittedly inadequate.”

There is no way to “sugarcoat” the transformation at the MUHC, Sidorowicz said in her letter, “it is profound and in some ways, a redefining moment for our hospital. The move to the Glen was a hugely challenging undertaking, but it turns out that the new positioning of the MUHC within a transforming health care network is as difficult, if not more so.”

Sidorowicz alluded to the 2007 clinical plan the hospital signed with the province, which the government says translates into a funding structure for beds at 85 per cent occupancy. The MUHC has unsuccessfully argued that the 2007 clinical plan is outdated and should be revised.

The bottom line: To avoid a deficit, the MUHC will have to operate with 799 beds.

“How will we be able to mitigate the impact of these bed closures?” Sidorowicz asked in her letter. It’s been an arduous, soul-searching task finding scenarios to minimize the impact on patients, for example, accepting fewer ambulances and repatriating patients to hospitals closer to their home, she said.

Asked to comment on how the province justifies funding the MUHC at 85 per cent, Julie White, Health Minister Gaétan Barrette’s press attaché, said the funding of beds at the MUHC is not any different than at other hospitals.

“The issue seems to be related to a clinical plan,” White said. “The MUHC had agreed to a clinical plan in 2007 and this plan must be applied.”

Sidorowicz was not available to comment. “In the coming days, we hope to announce a media briefing on the reorganization that is underway at the MUHC,” Ian Popple, a spokesperson with the hospital network, said.

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